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CNE Melissa Holland offers RN Katie MacLennan support at VGH.

“I can’t imagine going back to paper”: Island Health nurses support each other in the growing use of electronic health records

The theme for National Nursing Week in Canada, May 8-14, is “Our Nurses. Our Future” – an opportunity to celebrate Island Health nurses who are helping advance the electronic health record across the region.

Melissa Holland, RN and clinical nurse educator (CNE) at Victoria General Hospital (VGH), helps prepare other nurses for changes in their clinical practice – including the practice and workflow changes that come with electronic health records (EHR). She recalls the major shift from paper charting to electronic clinical documentation in 2021, and how important it is to adapt training to nurses’ learning needs.

“I really cater my orientation around electronic charting based on [a nurse’s] previous experience. So I can build on it as opposed to just assuming they know nothing and starting from scratch because that’s not actually helpful for them.”

Holland is already thinking ahead to early 2024 when physician orders – including medications, lab tests and imaging – at both VGH and Royal Jubilee Hospital (RJH) will move from paper forms to the electronic system known as CPOE, or computerized provider order entry, offering care team members across the system an immediate view into a patient’s detailed care plan.

“That’s where my mind is going right now, in terms of how do I best start to prepare staff for this change, what it could look like and how do we talk about it,” she said

Adopting new tools to support patient care

Carol Zanette and Michelle Law
CNE Carol Zanette (left) and RN Michelle Law work together in the PACU at NRGH

The transition to electronic health records, known as IHealth, continues steadily across Island Health. For thousands of Island Health nurses now using the EHR, this has meant hours of learning and practicing on the job, in classrooms and online, and collaborating with and helping colleagues who are new, or who are less confident with computers.

Those hours pay off – for both patients and care providers. RN Michelle Law has the information she needs at her fingertips when she admits a patient from surgery at Nanaimo Regional General Hospital (NRGH) to the Post Anesthesia Care Unit (PACU). Opening the record on the computer, Law can view a full list of the patient’s medications, post-surgery orders from the surgeon and other details entered by the admitting team, anesthesiologist and others – all before the patient arrives in the PACU.

“I’m considered an expert on the computer systems that we use – we’re all considered to be experts working this program,” she says. Law and her NRGH colleagues transitioned to the use of the EHR system in 2016. “Out in the general world, with that kind of stuff, I’m not that tech savvy. I think anyone can learn and use it to their advantage to get the most out of it.”

While many perceive the change to be mostly about technology, Law asserts the change is focused on patients.

“It’s just a machine, a computer,” she says. “You have to look at your patient first.”

Two generations, one electronic health records system

Sharon and Anna Nasonov
Sharon (left) and Anna Nasonov

Documenting electronically makes comprehensive patient information available in real time to the whole care team, supporting better communication and coordination and the best possible decisions for patient care. The system can also provide alerts to help the care team respond to emergency situations, such as sepsis (when an infection triggers a chain reaction throughout a patient’s entire body), further improving their ability to provide quality care.

Anna Nasonov, RN and nurse informaticist, is also thinking to the future. She is tasked with preparing nurses in the neonatal intensive care units for the change to EHR, and knows the difference it can make to have supportive nursing colleagues around you when the new system comes on stream.

“You want to see other people and talk to them, not only read something and listen or watch something. You need somebody at the bedside to help them and educate one-on-one,” she says.

Anna’s daughter, Sharon Nasonov, is also an RN, starting her nursing career two years ago at The Summit at Quadra Village long-term care residence in Victoria.
“All through [nursing] school, we had to use PowerChart the entire time,” says Sharon, who took that educational experience right into the workplace. Care teams at The Summit have access to advanced EHR tools like CPOE and PowerChart.

“I think it saves a lot of time on some things, like with [resident] care conferences, you just bring the workstation on wheels in with you, and you type it while you’re going.”

Sharon says she is often called upon to help older nurses with PowerChart. “You kind of get good at explaining it.”

Part of Island Health’s innovative approach is to advance the EHR across varied services, including acute, out-patient (ambulatory), community and long-term care services. In addition, Island Health’s MyHealth patient portal offers a secure website giving people 24/7 access to their personal health information – including laboratory, imaging and blood test results – from anywhere with an internet connection.

A passion for supporting learning

Back at NRGH, Carol Zanette, who works as a RN and clinical nurse educator, has spent six years on the education side of nursing. She was involved in supporting the transformation to the EHR in 2016.

“When it first came out, I would say that it was the most stressful thing I did in my career,” she says. “But I think the improvements to patient safety and to care have been tremendous.”

For many nurses, learning now to use the tools in the EHR is like “…learning a new language, it is just a massive learning curve,” she adds. Supporting that learning is Zanette’s passion, along with involvement in changes that can improve the quality of information that nurses have at their fingertips when they approach a patient and develop a plan for care.

“I can’t imagine going back to paper,” she says. “I’d say it’s far more concise, and you don’t have many pieces that you have to look for, like your paper order sets and some of your documentation…it just seems so much easier.

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